Code Bundling for CT Scans Negatively Affected Medicare Reimbursements

Written by Ronny Bachrach on May 5, 2014. Posted in DR

Many specialists in the medical imaging field have expressed concerns over the reimbursement policies from the federal government regarding procedures such as computed tomography. Their claims are not off base, however, as a study recently published in the American Journal of Roentgenology showed that the bundling of CT codes has led to a dramatic reduction in imaging payments.

Back in 2011, the Centers for Medicare and Medicaid Services implemented a change to the procedure codes for CT scans of the abdomen and pelvis. At the time, they were bundled together even though separate codes for both exams continued to exist. This caused the professional relative value units (RVUs) of the combined codes to be less than the RVUs from the separate sets. HealthImaging reported that, due to the frequency of CT scans of the pelvis and abdomen, the change in RVUs could have a significant impact on digital imaging reimbursements.

"Radiology has been hard-hit by reimbursement reductions. [This CT code bundling] is another example of a major cut, the magnitude of which may not have been fully anticipated. Although CMS will see this as helpful in their efforts to reduce healthcare costs, it could also lead to an adverse outcome – a loss of patient access to CT if payments continue to be reduced to the point at which providers can no longer cover their costs," wrote lead author David Levin, M.D., quoted by HealthImaging.

Drops in reimbursements
The researchers, led by Levin, Vijay Rao, M.D., and Laurence Parker, Ph.D., from Thomas Jefferson University, looked at the nationwide 2001-2011 Medicare Part B data files to choose codes for abdomen and pelvis CT scans both before and after the bundling was implemented, AuntMinnie.com explained. From there, Levin and his colleagues determined the volumes of procedures and calculated the utilization rates for every 1,000 Medicare beneficiaries.

They found that, before the codes were bundled, the overall procedure volume of CT scans of these anatomical areas in 2011 was roughly the same as the year prior. Once they were combined, however, the rate of procedures dipped. Subsequently, the reimbursements from Medicare, which had risen steadily through 2005 and remained relatively consistent through 2010, were reduced from $971.5 million to $687 million in 2011. Of the 29 percent decrease, estimated at approximately $284.5 million, radiologists experienced $218.6 million of the reduction.

"Because the utilization rate would have remained virtually unchanged in 2011 under the old coding method, the decrease was largely due to code bundling and the new lower RVU levels," concluded Levin, quoted by AuntMinnie.com.

The research from Thomas Jefferson University underscored the substantial effect that code bundling has had on the imaging reimbursements that radiologists receive from Medicare. However, it is expected to continue in other aspects of imaging, which could pose a significant financial threat to the field of diagnostic radiology. The technical and professional components of this healthcare branch could experience more cuts that could extend beyond the facility and impact patient care and health outcomes.

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Ronny Bachrach

Ronny Bachrach

Marketing Director at Viztek LLC
Responsible for all marketing activities including, press, advertising, trade show coordination, website management, dealer and customer communications.
Ronny Bachrach
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